First Line Therapy in Multiple Myeloma: VAD vs Bortezomib -Dexamethasone

Abstract

Multiple myeloma (MM) is typically sensitive to a range of cytotoxic agents, both as initial therapy and as relapsed disease treatment. Unfortunately, the responses are transient, and MM is not considered curable with the current approaches. This paper aims to assess the response to first line treatment of patients included in the study and their correlation with the negative prognostic factors in multiple myeloma: age over 60 years, male gender, anemia, hypercalcemia, elevated levels of creatinine, Beta 2 microglobulin, hypoalbuminemia and Bence-Jones proteins type. The study was conducted on a group of 105 patients admitted to the Hematology Department of the Municipal Emergency Clinical Hospital of Timisoara from 01 January 2013 until 31 December 2017. Twenty-seven patients received VAD regimen, while 78 underwent Bortezomib + Dexamethasone regimen as fist line therapy. When analyzing anthropometrical data, different gender distribution in the two groups of patients is seen, while a higher percentage of patients over 60 years is observed in both groups, with 77.7% in the VAD group (21 out of 27 patients) and 56.4% in the group treated with Bortezomib + Dexamethasone (44 out of 78 patients). Only some of the factors analyzed in our study statistically significantly influenced the response to treatment and the duration of survival, i.e.: age over 60 years, hemoglobin [10g/dL, platelets under 150000/mm3, creatinine ]2mg/dL, serum calcium ]10mg / dL, increased C-reactive protein, low serum albumin levels, high levels of Beta 2 microglobulin, total serum protein, as well as presence of cells in the peripheral smear. Defining a panel of negative prognostic factors that influence the evolution and response to multiple myeloma treatment would allow for tailoring of personalized therapies for each patient.

Glucocorticoid receptor expression in multiple myeloma patients is a predictor of survival

“…Based on previous work, one would expect the model to show significance for previously-established high risk 17p13 deletion [6,14]. Indeed, RR associated with this abnormality was 1.46, however not statistically significant.…”

Whole‑body diffusion‑weighted magnetic resonance imaging and apparent diffusion coefficient values as prognostic factors in multiple myeloma

“…Regarding treatment, no differences in pre-therapeutic or post-therapeutic ADC values were found in patients from both treatment regimen groups, although BD treatment represents the first line therapy ( 18 ). Although we obtained no significant differences, this is an interesting future study topic, as treatment options after induction therapy could be tailored after ADC values; and thus the patients would receive personalized treatment ( 19 ).…”

Risk Factors of Thrombophilia-Related Mutations for Early and Late Pregnancy Loss

“…(2) documented history of miscarriage(s) within the study timeframe; (3) consent to participate in the study and for the use of their medical records for research purposes; (4) a documented thrombophilia genetic panel. Exclusion criteria included (1) known chromosomal or anatomical abnormalities of the fetus; (2) history of induced abortion; (3) presence of autoimmune diseases and antiphospholipid syndrome; (4) incomplete medical records; (5) lack of consent to provide access to personal and medical records; (6) presence of comorbid factors that are known to influence the coagulation balance, such as malignancies [29][30][31], recent surgical procedures [32][33][34][35], and different hematologic disturbances and medication regimens [36,37].…”